Enhanced Patient Education for Colonic Polyp and Adenoma Detection: Meta-Analysis of Randomized Controlled Trials (Preprint)

BACKGROUND: Enhanced patient education (EPE) can improve the quality of bowel preparation before colonoscopy. However, it is uncertain whether EPE can increase the detection rate of colonic polyps and adenomas. OBJECTIVE: This meta-analysis aimed to evaluate the efficacy of EPE in detecting colonic polyps and adenomas. METHODS: We searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from their inception to June 2019 for the identification of trials comparing the EPE with standard patient education for outpatients undergoing colonoscopy. We used random effects model to calculate summary estimates of polyp detection rate (PDR, defined as the number of patients with at least 1 polyp divided by the total number of patients undergoing selective colonoscopy), adenoma detection rate (ADR, defined as the number of patients with at least 1 adenoma divided by the total number of patients undergoing selective colonoscopy), advanced adenoma detection rate (AADR, defined as the number of patients with at least 1 advanced adenoma divided by the total number of patients undergoing selective colonoscopy), sessile serrated adenoma detection rate (SSADR, defined as the number of patients with at least 1 sessile serrated adenoma divided by the total number of patients undergoing selective colonoscopy), cancer detection rate ([CDR] defined as the number of patients with at least 1 cancer divided by the total number of patients undergoing selective colonoscopy), or ADR-plus (defined as the number of additional adenomas found after the first adenoma per colonoscopy). Moreover, we also conducted trial sequential analysis (TSA) to determine the robustness of summary estimates of all primary outcomes. RESULTS: We included 10 randomized controlled trials enrolling 4560 participants for analysis. The meta-analysis suggested that EPE was associated with increased PDR (9 trials; 3781 participants; risk ratio [RR] 1.19; 95% CI 1.05-1.35; P<.05; I2=42%) and ADR (5 trials; 2133 participants; RR 1.37; 95% CI 1.15-1.64; P<.001; I2=0%), which were established by TSA. Pooled result from inverse-variance model illustrated an increase in SSADR (3 trials; 1248 participants; odds ratio 1.76; 95% CI 1.22-2.53; P<.05; I2=0%). One trial suggested an increase in ADR-plus (RR 4.39; 95% CI 2.91-6.61; P<.001). Pooled estimates from 3 (1649 participants) and 2 trials (1375 participants) generated no evidence of statistical difference for AADR and CDR, respectively. CONCLUSIONS: The current evidence indicates that EPE should be recommended to instruct bowel preparation in patients undergoing colonoscopy because it can increase the PDR, ADR, and SSADR. However, further trials are warranted to determine the efficacy of EPE for AADR, ADR-plus, and CDR because of limited data.